Nancy L. Heath

A Study of the Frequency of Self-Mutilation in a Community Sample of Adolescents

Currently little research exists examining self-mutilation (SM) in community samples of adolescents, despite tentative findings suggesting that self-harming behaviors, including SM may be increasing. The present study provides a comprehensive review of previous literature on the frequency of SM as well as preliminary epidemiological data concerning the frequency of SM in a community sample of high schools students. The relationship between SM, anxiety, and depressive symptomatology was also assessed. Four hundred and forty students from two schools, an urban and a suburban high school, were given a screening measure designed to assess for SM. Students who indicated that they hurt themselves on purpose also participated in a follow-up interview. Based on interviews it was found that 13.9% of all students reported having engaged in SM behavior at some time. Girls reported significantly higher rates of SM than did boys (64 vs. 36%, respectively). Self-cutting was found to be the most common type of SM, followed by self-hitting, pinching, scratching, and biting. Finally, students who self-mutilate reported significantly more anxiety and depressive symptomatology than students who did not self-mutilate. Results are also presented concerning demographic information and patterns of SM behavior.

Non‐Suicidal Self‐Injury and Eating Pathology in High School Students

Although past research has explored self-injurious behaviors and disordered eating among adults in clinical settings, little research has been conducted examining nonsuicidal self-injury (NSSI) and eating pathology in community samples of adolescents. Four hundred and 40 students were screened for the presence of NSSI; a prevalence rate of 13.9% was found. Those who indicated that they engaged in NSSI (n = 59) and a comparison group of non-self-injurers (n = 57) completed the Eating Disorders Inventory. Results indicate that students who engage in NSSI display significantly more eating pathology than their non-NSSI peers, including poor interoceptive awareness; difficulties with impulse regulation; an increased sense of ineffectiveness, distrust, and social insecurity; and increased bulimic tendencies and body dissatisfaction. Relationships were found between increased lifetime frequency of NSSI behaviors and poor impulse control and deficits in affective regulation. In addition, adolescents who had stopped self-injuring reported comparable rates of eating pathology as did adolescents who continued to self-injure. The theoretical connection between NSSI and eating pathology are discussed with reference to enhancing knowledge regarding the characteristics of NSSI.

Non-suicidal self-injury, youth, and the Internet: What mental health professionals need to know.

Non-suicidal self-injury (NSSI) content and related e-communication have proliferated on the Internet in recent years. Research indicates that many youth who self-injure go online to connect with others who self-injure and view others’ NSSI experiences and share their own through text and videos platforms. Although there are benefits to this behaviour in terms of receiving peer support, these activities can introduce these young people to risks, such as NSSI reinforcement through the sharing of stories and strategies, as well as, risks for triggering of NSSI urges. Due to the nature of these risks mental health professionals need to know about these risks and how to effectively assess adolescents’ online activity in order to adequately monitor the effects of the purported benefits and risks associated with NSSI content. This article offers research informed clinical guidelines for the assessment, intervention, and monitoring of online NSSI activities. To help bridge the gap between youth culture and mental health culture, these essentials include descriptions of Community, Social Networking, and Video/Photo Sharing websites and the terms associated with these websites. Assessment of these behaviours can be facilitated by a basic Functional Assessment approach that is further informed using specific recommended online questions tailored to NSSI online and an assessment of the frequency, duration, and time of day of the online activities. Intervention in this area should initially assess readiness for change and use motivational interviewing to encourage substitution of healthier online activities for the activities that may currently foster harm.

Positive Illusory Bias and the Self-Protective Hypothesis in Children With Learning Disabilities

We tested the hypothesis that overestimations of performance by children with learning disabilities (LD) are self-protective and will dissipate following positive feedback. Twenty-three boys and 17 girls with LD (ages 10.6 to 13.5 years) and a control group of non-LD matched children (22 boys and 17 girls) provided a prediction of their performance on a spelling test prior to completing the test. Subsequently, they were randomly assigned to either a positive feedback or a no-feedback condition. Finally, they provided a second prediction of performance on an equivalent spelling test. In children with LD, there was a positive bias in their predictions of performance, and, following positive feedback, their predictions became accurate. In children without LD, there was no positive bias and no effect of feedback. The results provide further support for the presence of a positive illusory bias and for the self-protective hypothesis in children with LD.

Prevalence and Expression of Depressive Symptomatology in Students with and without Learning Disabilities

The present study compared girls and boys with and without learning disabilities (LD) on mean reports of depressive symptoms, prevalence of depression and type of depressive symptoms reported. One hundred children with LD (46 girls, 54 boys) ana 104 children without LD (50 girls, 54 boys) were compared on the Childrens Depression Inventorys (Kovacs, 1992) overall score, percent meeting the cutoff for depression (19) and subscale factor scores indicating symptom patterns. Results revealed that (a) mean level of depressive symptoms between students with and without LD did not differ but prevalence of depression was marginally different; (b) girls with LD reported higher mean levels of depressive symptoms and higher prevalence of depression than girls without LD, whereas there was no difference in mean levels of depressive symptoms or prevalence of depression for boys with or without LD; (c) students with LD reported more symptoms of ineffectiveness; (d) girls reported more negative mood and less interpersonal problems than boys; and (e) girls with LD reported more symptoms indicative of a loss of pleasure, negative self-esteem and interpersonal problems relative to their peers without LD, while boys with or without LD did not differ in their symptom type reports. Implications and limitations of the results are discussed with reference to previous research and directions for future investigation.

Psychological distress in children with developmental coordination disorder and attention-deficit hyperactivity disorder.

This study explored whether or not a population-based sample of children with developmental coordination disorder (DCD), with and without comorbid attention deficit/hyperactivity disorder (ADHD), experienced higher levels of psychological distress than their peers. A two-stage procedure was used to identify 244 children: 68 with DCD only, 54 with ADHD only, 31 with comorbid DCD and ADHD, and 91 randomly selected typically developing (TD) children. Symptoms of depression and anxiety were measured by child and parent report. Child sex and caregiver ethnicity differed across groups, with a higher ratio of boys to girls in the ADHD only group and a slightly higher proportion of non-Caucasian caregivers in the TD group. After controlling for age, sex, and caregiver ethnicity, there was significant variation across groups in both anxiety (by parent report, F(3,235)=8.9, p<0.001; by child report, F(3,236)=5.6, p=0.001) and depression (parent report, F(3,236)=23.7, p<0.001; child report, F(3,238)=9.9, p<0.001). In general, children in all three disorder groups had significantly higher levels of symptoms than TD children, but most pairwise differences among those three groups were not significant. The one exception was the higher level of depressive symptoms noted by parent report in the ADHD/DCD group. In conclusion, children identified on the basis of motor coordination problems through a population-based screen showed significantly more symptoms of depression and anxiety than typically developing children. Children who have both DCD and ADHD are particularly at heightened risk of psychological distress.

Nonsuicidal Self‐Injury and Gender: Patterns of Prevalence, Methods, and Locations among Adolescents

Nonsuicidal self-injury (NSSI) among adolescents is a growing concern. However, little is known about gender and features of this behavior. Gender differences in NSSI among a sample of 7,126 adolescents were investigated, 1,774 of whom reported having engaged in NSSI. Gender differences in prevalence, method, and location of NSSI were examined. Findings revealed that females reported higher rates of NSSI, more cutting and scratching, and more injuries to arms and legs than their male counterparts. Males reported more burning and hitting-type behavior, as well as injuries to the chest, face, or genitals. This highlights an interesting pattern of NSSI, which future research should consider to accurately examine NSSI in females and males.

“I Am Not Well-Equipped” High School Teachers’ Perceptions of Self-Injury

Fifty teachers completed a survey to investigate knowledge, self-perceived knowledge, and attitudes regarding self-injury (SI). Teachers were aware of basic facts concerning SI; however, 78% underestimated prevalence, and only 20% felt knowledgeable. Attitudes were mixed, with 48% finding the idea of SI horrifying; however, 68% disagreeing that SI was “often manipulative.” Principal components analysis indicated that perceived knowledge emerged as a separate construct from attitudes toward SI. Years of teaching experience was related to self-perceived knowledge, but not to attitudes. In addition, 74% of teachers reported having a personal encounter with SI, and 62% felt that SI is increasing in the schools. Qualitative analysis of open-ended questions revealed a strong desire for further knowledge and training. Results indicate that teachers’ perceptions are not consistent with studies of SI in clinical settings but are consistent with recent research in community and school samples. The need for teacher education about SI is emphasized.

Depression and Nonacademic Self-Perceptions in Children with and without Learning Disabilities.

Nonacademic self-perceptions (social acceptance, athletic ability, physical appearance and behavioral conduct) of depressed and nondepressed children with and without learning disabilities were compared. The nonacademic subscales of the Self-Perception Profile for Learning Disabled Students, a domain-specific self-perception measure, and the Childrens Depression Inventory, a self-report inventory of depressive symptomatology, were administered to students in grade 5 (n=83) and grade 8 (n=88). Results indicated that self-perceived social acceptance demonstrated a significant relationship with depression only for students with learning disabilities. Furthermore, lower self-perception of physical appearance was related to depression for females but not males. Depressed subjects, regardless of gender, reported lower self-perceptions of behavioral conduct and athletic ability. Consistent with previous findings regarding stereotypical self-perceptions, males reported better self-perceptions of athletic ability than females but lower self-perceptions of behavioral conduct. Clinical and theoretical implications are discussed.

Recognition, Expression, and Understanding Facial Expressions of Emotion in Adolescents With Nonverbal and General Learning Disabilities:

Children with nonverbal learning disabilities (NVLD) have been found to be worse at recognizing facial expressions than children with verbal learning disabilities (LD) and without LD. However, little research has been done with adolescents. In addition, expressing and understanding facial expressions is yet to be studied among adolescents with LD subtypes. This study examined abilities of adolescents with NVLD, with general learning disabilities (GLD), and without LD to recognize, express, and understand facial expressions of emotion. Adolescents were grouped into those with NVLD, with GLD, and without LD using the Wechsler Intelligence Scale for Children—Third Edition (short form) and Wide Range Achievement Test—Third Edition. The adolescents completed neuropsychological, recognition, expression, and understanding measures. It is intriguing that the GLD group was significantly less accurate at recognizing and understanding facial expressions compared with the NVLD and NLD groups, who did not differ. Implications are explored with regard to the need to consider possible deficits in recognition and understanding of emotion in adolescents with LD in schools.